title: Mortality and causes of death in children referred to a tertiary epilepsy center.
abstract: BACKGROUND
  Patients with epilepsy, including children, have an increased mortality rate when compared to the general population. Only few studies on causes of mortality in childhood epilepsy exist and pediatric SUDEP rate is under continuous discussion.
  
  
  OBJECTIVE
  To describe general mortality, incidence of sudden unexpected death in epilepsy (SUDEP), causes of death and age distribution in a pediatric epilepsy patient population.
  
  
  METHODS
  The study retrospectively examined the mortality and causes of death in 1974 patients with childhood-onset epilepsy at a tertiary epilepsy center in Denmark over a period of 9 years. Cases of death were identified through their unique civil registration number. Information from death certificates, autopsy reports and medical notes were collected.
  
  
  RESULTS
  2.2% (n = 43) of the patient cohort died during the study period. This includes 9 patients with SUDEP (8 SUDEP cases per 10,000 patient years). 9 patients died in the course of neurodegenerative disease and 28 children died of various causes. Epilepsy was considered drug resistant in more than 95% of the deceased patients, 90% were diagnosed with intellectual disability. Mortality of patients that underwent dietary epilepsy treatment was slightly higher than in the general cohort. There were no epilepsy-related deaths due to drowning.
  
  
  CONCLUSIONS
  This study confirms that SUDEP must not be disregarded in the pediatric age group. The vast majority of SUDEP cases in this study displays numerous risk factors similar to those described in adult epilepsy patients. Including SUDEP, only 30% of the mortality was directly seizure related.
authors.affiliation: Danish Epilepsy Center Filadelfia, Children's Department, Kolonivej 1, 4293 Dianalund, Denmark. Electronic address: sabine.groenborg@regionh.dk.
authors.forename: Sabine
authors.initials: S
authors.lastname: Grønborg
authors.affiliation: Danish Epilepsy Center Filadelfia, Children's Department, Kolonivej 1, 4293 Dianalund, Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Uldall
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003645:Death, Sudden / Q000209:etiology; D003718:Denmark; D004827:Epilepsy / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D015994:Incidence; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
keywords: Causes of death; Drug resistant epilepsy; Mortality; Pediatric epilepsy; SUDEP